|
VINBLASTINE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
OP
|
$507.28
|
|
|
Service Code
|
HCPCS J9360
|
| Hospital Charge Code |
8594
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$13.61 |
| Max. Negotiated Rate |
$456.55 |
| Rate for Payer: Aetna American Axle |
$329.73
|
| Rate for Payer: Aetna Commercial |
$431.19
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$329.73
|
| Rate for Payer: BCBS Complete |
$202.91
|
| Rate for Payer: BCBS Trust/PPO |
$13.61
|
| Rate for Payer: Cash Price |
$405.82
|
| Rate for Payer: Cash Price |
$405.82
|
| Rate for Payer: Cofinity Commercial |
$355.10
|
| Rate for Payer: Cofinity Commercial |
$436.26
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$405.82
|
| Rate for Payer: Healthscope Commercial |
$456.55
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$355.10
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$380.46
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$431.19
|
| Rate for Payer: PHP Commercial |
$431.19
|
| Rate for Payer: Priority Health Cigna Priority Health |
$355.10
|
| Rate for Payer: Priority Health SBD |
$319.59
|
| Rate for Payer: UMR Bronson Commercial |
$187.69
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$380.46
|
|
|
VINCRISTINE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
OP
|
$140.00
|
|
|
Service Code
|
HCPCS J9370
|
| Hospital Charge Code |
8597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna American Axle |
$91.00
|
| Rate for Payer: Aetna Commercial |
$119.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.00
|
| Rate for Payer: BCBS Complete |
$56.00
|
| Rate for Payer: BCBS Trust/PPO |
$24.96
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$120.40
|
| Rate for Payer: Cofinity Commercial |
$98.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.00
|
| Rate for Payer: Healthscope Commercial |
$126.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.00
|
| Rate for Payer: PHP Commercial |
$119.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.00
|
| Rate for Payer: Priority Health SBD |
$88.20
|
| Rate for Payer: UMR Bronson Commercial |
$51.80
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.00
|
|
|
VINCRISTINE 1 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$140.00
|
|
|
Service Code
|
HCPCS J9370
|
| Hospital Charge Code |
8597
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$61.60 |
| Max. Negotiated Rate |
$126.00 |
| Rate for Payer: Aetna American Axle |
$91.00
|
| Rate for Payer: Aetna Commercial |
$119.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$91.00
|
| Rate for Payer: Cash Price |
$112.00
|
| Rate for Payer: Cofinity Commercial |
$120.40
|
| Rate for Payer: Cofinity Commercial |
$98.00
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$112.00
|
| Rate for Payer: Healthscope Commercial |
$126.00
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$98.00
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$105.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$119.00
|
| Rate for Payer: PHP Commercial |
$119.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$98.00
|
| Rate for Payer: Priority Health SBD |
$88.20
|
| Rate for Payer: UMR Bronson Commercial |
$61.60
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$105.00
|
|
|
VINCRISTINE 2 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
OP
|
$190.65
|
|
|
Service Code
|
HCPCS J9370
|
| Hospital Charge Code |
118463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.96 |
| Max. Negotiated Rate |
$171.58 |
| Rate for Payer: Aetna American Axle |
$123.92
|
| Rate for Payer: Aetna Commercial |
$162.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.92
|
| Rate for Payer: BCBS Complete |
$76.26
|
| Rate for Payer: BCBS Trust/PPO |
$24.96
|
| Rate for Payer: Cash Price |
$152.52
|
| Rate for Payer: Cash Price |
$152.52
|
| Rate for Payer: Cofinity Commercial |
$133.46
|
| Rate for Payer: Cofinity Commercial |
$163.96
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.52
|
| Rate for Payer: Healthscope Commercial |
$171.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.46
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$162.05
|
| Rate for Payer: PHP Commercial |
$162.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.46
|
| Rate for Payer: Priority Health SBD |
$120.11
|
| Rate for Payer: UMR Bronson Commercial |
$70.54
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.99
|
|
|
VINCRISTINE 2 MG/2 ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$190.65
|
|
|
Service Code
|
HCPCS J9370
|
| Hospital Charge Code |
118463
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$83.89 |
| Max. Negotiated Rate |
$171.58 |
| Rate for Payer: Aetna American Axle |
$123.92
|
| Rate for Payer: Aetna American Axle |
$195.65
|
| Rate for Payer: Aetna Commercial |
$255.85
|
| Rate for Payer: Aetna Commercial |
$162.05
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$195.65
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$123.92
|
| Rate for Payer: Cash Price |
$240.80
|
| Rate for Payer: Cash Price |
$152.52
|
| Rate for Payer: Cofinity Commercial |
$133.46
|
| Rate for Payer: Cofinity Commercial |
$163.96
|
| Rate for Payer: Cofinity Commercial |
$258.86
|
| Rate for Payer: Cofinity Commercial |
$210.70
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$240.80
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$152.52
|
| Rate for Payer: Healthscope Commercial |
$270.90
|
| Rate for Payer: Healthscope Commercial |
$171.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$133.46
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$210.70
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$225.75
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$142.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$255.85
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$162.05
|
| Rate for Payer: PHP Commercial |
$255.85
|
| Rate for Payer: PHP Commercial |
$162.05
|
| Rate for Payer: Priority Health Cigna Priority Health |
$210.70
|
| Rate for Payer: Priority Health Cigna Priority Health |
$133.46
|
| Rate for Payer: Priority Health SBD |
$189.63
|
| Rate for Payer: Priority Health SBD |
$120.11
|
| Rate for Payer: UMR Bronson Commercial |
$83.89
|
| Rate for Payer: UMR Bronson Commercial |
$132.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$142.99
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$225.75
|
|
|
VINORELBINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
OP
|
$298.38
|
|
|
Service Code
|
HCPCS J9390
|
| Hospital Charge Code |
14203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.95 |
| Max. Negotiated Rate |
$268.54 |
| Rate for Payer: Aetna American Axle |
$193.95
|
| Rate for Payer: Aetna Commercial |
$253.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.95
|
| Rate for Payer: BCBS Complete |
$119.35
|
| Rate for Payer: BCBS Trust/PPO |
$23.95
|
| Rate for Payer: Cash Price |
$238.70
|
| Rate for Payer: Cash Price |
$238.70
|
| Rate for Payer: Cofinity Commercial |
$208.87
|
| Rate for Payer: Cofinity Commercial |
$256.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.70
|
| Rate for Payer: Healthscope Commercial |
$268.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$208.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$253.62
|
| Rate for Payer: PHP Commercial |
$253.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.87
|
| Rate for Payer: Priority Health SBD |
$187.98
|
| Rate for Payer: UMR Bronson Commercial |
$110.40
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.78
|
|
|
VINORELBINE 10 MG/ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$298.38
|
|
|
Service Code
|
HCPCS J9390
|
| Hospital Charge Code |
14203
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$131.29 |
| Max. Negotiated Rate |
$268.54 |
| Rate for Payer: Aetna American Axle |
$193.95
|
| Rate for Payer: Aetna Commercial |
$253.62
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$193.95
|
| Rate for Payer: Cash Price |
$238.70
|
| Rate for Payer: Cofinity Commercial |
$208.87
|
| Rate for Payer: Cofinity Commercial |
$256.61
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$238.70
|
| Rate for Payer: Healthscope Commercial |
$268.54
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$208.87
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$223.78
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$253.62
|
| Rate for Payer: PHP Commercial |
$253.62
|
| Rate for Payer: Priority Health Cigna Priority Health |
$208.87
|
| Rate for Payer: Priority Health SBD |
$187.98
|
| Rate for Payer: UMR Bronson Commercial |
$131.29
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$223.78
|
|
|
VINORELBINE 50 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
OP
|
$324.11
|
|
|
Service Code
|
HCPCS J9390
|
| Hospital Charge Code |
41673
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$23.95 |
| Max. Negotiated Rate |
$291.70 |
| Rate for Payer: Aetna American Axle |
$210.67
|
| Rate for Payer: Aetna Commercial |
$275.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.67
|
| Rate for Payer: BCBS Complete |
$129.64
|
| Rate for Payer: BCBS Trust/PPO |
$23.95
|
| Rate for Payer: Cash Price |
$259.29
|
| Rate for Payer: Cash Price |
$259.29
|
| Rate for Payer: Cofinity Commercial |
$226.88
|
| Rate for Payer: Cofinity Commercial |
$278.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.29
|
| Rate for Payer: Healthscope Commercial |
$291.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$226.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$275.49
|
| Rate for Payer: PHP Commercial |
$275.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.88
|
| Rate for Payer: Priority Health SBD |
$204.19
|
| Rate for Payer: UMR Bronson Commercial |
$119.92
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.08
|
|
|
VINORELBINE 50 MG/5 ML INTRAVENOUS SOLUTION
|
Facility
IP
|
$324.11
|
|
|
Service Code
|
HCPCS J9390
|
| Hospital Charge Code |
41673
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$142.61 |
| Max. Negotiated Rate |
$291.70 |
| Rate for Payer: Aetna American Axle |
$210.67
|
| Rate for Payer: Aetna Commercial |
$275.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$210.67
|
| Rate for Payer: Cash Price |
$259.29
|
| Rate for Payer: Cofinity Commercial |
$226.88
|
| Rate for Payer: Cofinity Commercial |
$278.73
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$259.29
|
| Rate for Payer: Healthscope Commercial |
$291.70
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$226.88
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$243.08
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$275.49
|
| Rate for Payer: PHP Commercial |
$275.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$226.88
|
| Rate for Payer: Priority Health SBD |
$204.19
|
| Rate for Payer: UMR Bronson Commercial |
$142.61
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$243.08
|
|
|
VIRAL ILLNESS WITH MCC
|
Facility
IP
|
$25,548.65
|
|
|
Service Code
|
MS-DRG 865
|
| Min. Negotiated Rate |
$12,492.02 |
| Max. Negotiated Rate |
$25,548.65 |
| Rate for Payer: Aetna Medicare |
$13,675.47
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$16,436.86
|
| Rate for Payer: Amish Plain Church Group Commercial |
$16,436.86
|
| Rate for Payer: BCBS MAPPO |
$13,149.49
|
| Rate for Payer: BCBS Trust/PPO |
$25,548.65
|
| Rate for Payer: BCN Medicare Advantage |
$13,149.49
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$13,149.49
|
| Rate for Payer: Mclaren Medicare |
$13,149.49
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$13,806.96
|
| Rate for Payer: MI Amish Medical Board Commercial |
$15,121.91
|
| Rate for Payer: PACE Medicare |
$12,492.02
|
| Rate for Payer: PACE SWMI |
$13,149.49
|
| Rate for Payer: PHP Medicare Advantage |
$13,149.49
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$23,532.43
|
| Rate for Payer: Priority Health Medicare |
$13,149.49
|
| Rate for Payer: Priority Health Narrow Network |
$18,825.94
|
| Rate for Payer: Railroad Medicare Medicare |
$13,149.49
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$25,015.03
|
| Rate for Payer: UHC Core |
$20,511.87
|
| Rate for Payer: UHC Dual Complete DSNP |
$13,149.49
|
| Rate for Payer: UHC Exchange |
$16,307.17
|
| Rate for Payer: UHC Medicare Advantage |
$13,543.97
|
| Rate for Payer: VA VA |
$13,149.49
|
|
|
VIRAL ILLNESS WITHOUT MCC
|
Facility
IP
|
$13,998.60
|
|
|
Service Code
|
MS-DRG 866
|
| Min. Negotiated Rate |
$7,204.97 |
| Max. Negotiated Rate |
$13,998.60 |
| Rate for Payer: Aetna Medicare |
$7,887.55
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,480.22
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,480.22
|
| Rate for Payer: BCBS MAPPO |
$7,584.18
|
| Rate for Payer: BCBS Trust/PPO |
$11,511.59
|
| Rate for Payer: BCN Medicare Advantage |
$7,584.18
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,584.18
|
| Rate for Payer: Mclaren Medicare |
$7,584.18
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$7,963.39
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,721.81
|
| Rate for Payer: PACE Medicare |
$7,204.97
|
| Rate for Payer: PACE SWMI |
$7,584.18
|
| Rate for Payer: PHP Medicare Advantage |
$7,584.18
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,168.92
|
| Rate for Payer: Priority Health Medicare |
$7,584.18
|
| Rate for Payer: Priority Health Narrow Network |
$10,535.14
|
| Rate for Payer: Railroad Medicare Medicare |
$7,584.18
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$13,998.60
|
| Rate for Payer: UHC Core |
$11,478.59
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,584.18
|
| Rate for Payer: UHC Exchange |
$9,125.61
|
| Rate for Payer: UHC Medicare Advantage |
$7,811.71
|
| Rate for Payer: VA VA |
$7,584.18
|
|
|
VIRAL MENINGITIS WITH CC/MCC
|
Facility
IP
|
$29,193.11
|
|
|
Service Code
|
MS-DRG 075
|
| Min. Negotiated Rate |
$14,497.14 |
| Max. Negotiated Rate |
$29,193.11 |
| Rate for Payer: Aetna Medicare |
$15,870.56
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$19,075.19
|
| Rate for Payer: Amish Plain Church Group Commercial |
$19,075.19
|
| Rate for Payer: BCBS MAPPO |
$15,260.15
|
| Rate for Payer: BCBS Trust/PPO |
$19,276.46
|
| Rate for Payer: BCN Medicare Advantage |
$15,260.15
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$15,260.15
|
| Rate for Payer: Mclaren Medicare |
$15,260.15
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$16,023.16
|
| Rate for Payer: MI Amish Medical Board Commercial |
$17,549.17
|
| Rate for Payer: PACE Medicare |
$14,497.14
|
| Rate for Payer: PACE SWMI |
$15,260.15
|
| Rate for Payer: PHP Medicare Advantage |
$15,260.15
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$27,462.88
|
| Rate for Payer: Priority Health Medicare |
$15,260.15
|
| Rate for Payer: Priority Health Narrow Network |
$21,970.30
|
| Rate for Payer: Railroad Medicare Medicare |
$15,260.15
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$29,193.11
|
| Rate for Payer: UHC Core |
$23,937.81
|
| Rate for Payer: UHC Dual Complete DSNP |
$15,260.15
|
| Rate for Payer: UHC Exchange |
$19,030.83
|
| Rate for Payer: UHC Medicare Advantage |
$15,717.95
|
| Rate for Payer: VA VA |
$15,260.15
|
|
|
VIRAL MENINGITIS WITHOUT CC/MCC
|
Facility
IP
|
$14,071.82
|
|
|
Service Code
|
MS-DRG 076
|
| Min. Negotiated Rate |
$7,240.11 |
| Max. Negotiated Rate |
$14,071.82 |
| Rate for Payer: Aetna Medicare |
$7,926.02
|
| Rate for Payer: Allen County Amish Medical Aid Commercial |
$9,526.46
|
| Rate for Payer: Amish Plain Church Group Commercial |
$9,526.46
|
| Rate for Payer: BCBS MAPPO |
$7,621.17
|
| Rate for Payer: BCBS Trust/PPO |
$11,152.25
|
| Rate for Payer: BCN Medicare Advantage |
$7,621.17
|
| Rate for Payer: Health Alliance Plan Medicare Advantage |
$7,621.17
|
| Rate for Payer: Mclaren Medicare |
$7,621.17
|
| Rate for Payer: Meridian Wellcare - Medicare Advantage |
$8,002.23
|
| Rate for Payer: MI Amish Medical Board Commercial |
$8,764.35
|
| Rate for Payer: PACE Medicare |
$7,240.11
|
| Rate for Payer: PACE SWMI |
$7,621.17
|
| Rate for Payer: PHP Medicare Advantage |
$7,621.17
|
| Rate for Payer: Priority Health HMO/PPO/Tiered Network |
$13,237.80
|
| Rate for Payer: Priority Health Medicare |
$7,621.17
|
| Rate for Payer: Priority Health Narrow Network |
$10,590.24
|
| Rate for Payer: Railroad Medicare Medicare |
$7,621.17
|
| Rate for Payer: UHC All Payor (Choice/PPO) |
$14,071.82
|
| Rate for Payer: UHC Core |
$11,538.63
|
| Rate for Payer: UHC Dual Complete DSNP |
$7,621.17
|
| Rate for Payer: UHC Exchange |
$9,173.34
|
| Rate for Payer: UHC Medicare Advantage |
$7,849.81
|
| Rate for Payer: VA VA |
$7,621.17
|
|
|
VIT A 5,000 UNIT-VIT C 60 MG-VIT E 30 UNIT-ZINC-SELENATE-COPPER TABLET
|
Facility
IP
|
$78.96
|
|
|
Service Code
|
NDC 904773518
|
| Hospital Charge Code |
173055
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$34.74 |
| Max. Negotiated Rate |
$71.06 |
| Rate for Payer: Aetna American Axle |
$51.32
|
| Rate for Payer: Aetna Commercial |
$67.12
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$51.32
|
| Rate for Payer: Cash Price |
$63.17
|
| Rate for Payer: Cofinity Commercial |
$55.27
|
| Rate for Payer: Cofinity Commercial |
$67.91
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$63.17
|
| Rate for Payer: Healthscope Commercial |
$71.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$55.27
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$59.22
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$67.12
|
| Rate for Payer: PHP Commercial |
$67.12
|
| Rate for Payer: Priority Health Cigna Priority Health |
$55.27
|
| Rate for Payer: Priority Health SBD |
$49.74
|
| Rate for Payer: UMR Bronson Commercial |
$34.74
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$59.22
|
|
|
VIT A-D3-E-ALOE VERA-ZINC TOPICAL OINTMENT
|
Facility
IP
|
$15.30
|
|
|
Service Code
|
NDC 61924-205-04
|
| Hospital Charge Code |
115852
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$6.73 |
| Max. Negotiated Rate |
$13.77 |
| Rate for Payer: Aetna American Axle |
$9.94
|
| Rate for Payer: Aetna Commercial |
$13.00
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$9.94
|
| Rate for Payer: Cash Price |
$12.24
|
| Rate for Payer: Cofinity Commercial |
$10.71
|
| Rate for Payer: Cofinity Commercial |
$13.16
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$12.24
|
| Rate for Payer: Healthscope Commercial |
$13.77
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$10.71
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$11.48
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$13.00
|
| Rate for Payer: PHP Commercial |
$13.00
|
| Rate for Payer: Priority Health Cigna Priority Health |
$10.71
|
| Rate for Payer: Priority Health SBD |
$9.64
|
| Rate for Payer: UMR Bronson Commercial |
$6.73
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$11.48
|
|
|
VITAMIN A 2,400 MCG CAPSULE
|
Facility
IP
|
$98.70
|
|
|
Service Code
|
NDC 54629-0110-01
|
| Hospital Charge Code |
8641
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$43.43 |
| Max. Negotiated Rate |
$88.83 |
| Rate for Payer: Aetna American Axle |
$64.16
|
| Rate for Payer: Aetna Commercial |
$83.90
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$64.16
|
| Rate for Payer: Cash Price |
$78.96
|
| Rate for Payer: Cofinity Commercial |
$69.09
|
| Rate for Payer: Cofinity Commercial |
$84.88
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$78.96
|
| Rate for Payer: Healthscope Commercial |
$88.83
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$69.09
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$74.02
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$83.90
|
| Rate for Payer: PHP Commercial |
$83.90
|
| Rate for Payer: Priority Health Cigna Priority Health |
$69.09
|
| Rate for Payer: Priority Health SBD |
$62.18
|
| Rate for Payer: UMR Bronson Commercial |
$43.43
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$74.02
|
|
|
VITAMIN A 3,000 MCG (10,000 UNIT) CAPSULE
|
Facility
IP
|
$148.00
|
|
|
Service Code
|
NDC 904208560
|
| Hospital Charge Code |
8639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$65.12 |
| Max. Negotiated Rate |
$133.20 |
| Rate for Payer: Aetna American Axle |
$96.20
|
| Rate for Payer: Aetna Commercial |
$125.80
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$96.20
|
| Rate for Payer: Cash Price |
$118.40
|
| Rate for Payer: Cofinity Commercial |
$103.60
|
| Rate for Payer: Cofinity Commercial |
$127.28
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$118.40
|
| Rate for Payer: Healthscope Commercial |
$133.20
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$103.60
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$111.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$125.80
|
| Rate for Payer: PHP Commercial |
$125.80
|
| Rate for Payer: Priority Health Cigna Priority Health |
$103.60
|
| Rate for Payer: Priority Health SBD |
$93.24
|
| Rate for Payer: UMR Bronson Commercial |
$65.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$111.00
|
|
|
VITAMIN A 3,000 MCG (10,000 UNIT) CAPSULE
|
Facility
IP
|
$164.00
|
|
|
Service Code
|
NDC 761043310
|
| Hospital Charge Code |
8639
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$72.16 |
| Max. Negotiated Rate |
$147.60 |
| Rate for Payer: Aetna American Axle |
$106.60
|
| Rate for Payer: Aetna Commercial |
$139.40
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$106.60
|
| Rate for Payer: Cash Price |
$131.20
|
| Rate for Payer: Cofinity Commercial |
$114.80
|
| Rate for Payer: Cofinity Commercial |
$141.04
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$131.20
|
| Rate for Payer: Healthscope Commercial |
$147.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$114.80
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$123.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$139.40
|
| Rate for Payer: PHP Commercial |
$139.40
|
| Rate for Payer: Priority Health Cigna Priority Health |
$114.80
|
| Rate for Payer: Priority Health SBD |
$103.32
|
| Rate for Payer: UMR Bronson Commercial |
$72.16
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$123.00
|
|
|
VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET
|
Facility
IP
|
$103.40
|
|
|
Service Code
|
NDC 536730001
|
| Hospital Charge Code |
29833
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$93.06 |
| Rate for Payer: Aetna American Axle |
$67.21
|
| Rate for Payer: Aetna Commercial |
$87.89
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$67.21
|
| Rate for Payer: Cash Price |
$82.72
|
| Rate for Payer: Cofinity Commercial |
$72.38
|
| Rate for Payer: Cofinity Commercial |
$88.92
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$82.72
|
| Rate for Payer: Healthscope Commercial |
$93.06
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$72.38
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$77.55
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$87.89
|
| Rate for Payer: PHP Commercial |
$87.89
|
| Rate for Payer: Priority Health Cigna Priority Health |
$72.38
|
| Rate for Payer: Priority Health SBD |
$65.14
|
| Rate for Payer: UMR Bronson Commercial |
$45.50
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$77.55
|
|
|
VITAMIN B COMPLEX-VITAMIN C-FOLIC ACID 0.8 MG TABLET
|
Facility
IP
|
$138.65
|
|
|
Service Code
|
NDC 6025816001
|
| Hospital Charge Code |
29833
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$61.01 |
| Max. Negotiated Rate |
$124.78 |
| Rate for Payer: Aetna American Axle |
$90.12
|
| Rate for Payer: Aetna Commercial |
$117.85
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$90.12
|
| Rate for Payer: Cash Price |
$110.92
|
| Rate for Payer: Cofinity Commercial |
$119.24
|
| Rate for Payer: Cofinity Commercial |
$97.06
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$110.92
|
| Rate for Payer: Healthscope Commercial |
$124.78
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$97.06
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$103.99
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$117.85
|
| Rate for Payer: PHP Commercial |
$117.85
|
| Rate for Payer: Priority Health Cigna Priority Health |
$97.06
|
| Rate for Payer: Priority Health SBD |
$87.35
|
| Rate for Payer: UMR Bronson Commercial |
$61.01
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$103.99
|
|
|
VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) CAPSULE
|
Facility
IP
|
$174.90
|
|
|
Service Code
|
NDC 7733395110
|
| Hospital Charge Code |
118622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$76.96 |
| Max. Negotiated Rate |
$157.41 |
| Rate for Payer: Aetna American Axle |
$113.68
|
| Rate for Payer: Aetna Commercial |
$148.66
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$113.68
|
| Rate for Payer: Cash Price |
$139.92
|
| Rate for Payer: Cofinity Commercial |
$122.43
|
| Rate for Payer: Cofinity Commercial |
$150.41
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$139.92
|
| Rate for Payer: Healthscope Commercial |
$157.41
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$122.43
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$131.18
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$148.66
|
| Rate for Payer: PHP Commercial |
$148.66
|
| Rate for Payer: Priority Health Cigna Priority Health |
$122.43
|
| Rate for Payer: Priority Health SBD |
$110.19
|
| Rate for Payer: UMR Bronson Commercial |
$76.96
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$131.18
|
|
|
VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) CAPSULE
|
Facility
IP
|
$176.00
|
|
|
Service Code
|
NDC 9629513796
|
| Hospital Charge Code |
118622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$77.44 |
| Max. Negotiated Rate |
$158.40 |
| Rate for Payer: Aetna American Axle |
$114.40
|
| Rate for Payer: Aetna Commercial |
$149.60
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$114.40
|
| Rate for Payer: Cash Price |
$140.80
|
| Rate for Payer: Cofinity Commercial |
$123.20
|
| Rate for Payer: Cofinity Commercial |
$151.36
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$140.80
|
| Rate for Payer: Healthscope Commercial |
$158.40
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$123.20
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$132.00
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$149.60
|
| Rate for Payer: PHP Commercial |
$149.60
|
| Rate for Payer: Priority Health Cigna Priority Health |
$123.20
|
| Rate for Payer: Priority Health SBD |
$110.88
|
| Rate for Payer: UMR Bronson Commercial |
$77.44
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$132.00
|
|
|
VITAMIN E (DL, ACETATE) 180 MG (400 UNIT) CAPSULE
|
Facility
IP
|
$1.75
|
|
|
Service Code
|
NDC 7733395125
|
| Hospital Charge Code |
118622
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$0.77 |
| Max. Negotiated Rate |
$1.58 |
| Rate for Payer: Aetna American Axle |
$1.14
|
| Rate for Payer: Aetna Commercial |
$1.49
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$1.14
|
| Rate for Payer: Cash Price |
$1.40
|
| Rate for Payer: Cofinity Commercial |
$1.22
|
| Rate for Payer: Cofinity Commercial |
$1.50
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$1.40
|
| Rate for Payer: Healthscope Commercial |
$1.58
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$1.22
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$1.31
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$1.49
|
| Rate for Payer: PHP Commercial |
$1.49
|
| Rate for Payer: Priority Health Cigna Priority Health |
$1.22
|
| Rate for Payer: Priority Health SBD |
$1.10
|
| Rate for Payer: UMR Bronson Commercial |
$0.77
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$1.31
|
|
|
VITAMIN E (DL, ACETATE) 22.5 MG (50 UNIT)/ML ORAL DROPS
|
Facility
IP
|
$93.46
|
|
|
Service Code
|
NDC 7132180230
|
| Hospital Charge Code |
116319
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$41.12 |
| Max. Negotiated Rate |
$84.11 |
| Rate for Payer: Aetna American Axle |
$60.75
|
| Rate for Payer: Aetna Commercial |
$79.44
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$60.75
|
| Rate for Payer: Cash Price |
$74.77
|
| Rate for Payer: Cofinity Commercial |
$65.42
|
| Rate for Payer: Cofinity Commercial |
$80.38
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$74.77
|
| Rate for Payer: Healthscope Commercial |
$84.11
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$65.42
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$70.10
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$79.44
|
| Rate for Payer: PHP Commercial |
$79.44
|
| Rate for Payer: Priority Health Cigna Priority Health |
$65.42
|
| Rate for Payer: Priority Health SBD |
$58.88
|
| Rate for Payer: UMR Bronson Commercial |
$41.12
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$70.10
|
|
|
VITAMIN E (DL, ACETATE) 450 MG (1,000 UNIT) CAPSULE
|
Facility
IP
|
$81.78
|
|
|
Service Code
|
NDC 904027746
|
| Hospital Charge Code |
152874
|
|
Hospital Revenue Code
|
637
|
| Min. Negotiated Rate |
$35.98 |
| Max. Negotiated Rate |
$73.60 |
| Rate for Payer: Aetna American Axle |
$53.16
|
| Rate for Payer: Aetna Commercial |
$69.51
|
| Rate for Payer: Aetna New Business (MI Preferred) |
$53.16
|
| Rate for Payer: Cash Price |
$65.42
|
| Rate for Payer: Cofinity Commercial |
$57.25
|
| Rate for Payer: Cofinity Commercial |
$70.33
|
| Rate for Payer: Encore Health Key Benefits Commercial |
$65.42
|
| Rate for Payer: Healthscope Commercial |
$73.60
|
| Rate for Payer: Kalamazoo County Sherrif's Dept Commercial |
$57.25
|
| Rate for Payer: Lakeland Regional Health Systems Commercial |
$61.34
|
| Rate for Payer: Multiplan/Beech St/PHCS Multiplan/Beech St/PHCS |
$69.51
|
| Rate for Payer: PHP Commercial |
$69.51
|
| Rate for Payer: Priority Health Cigna Priority Health |
$57.25
|
| Rate for Payer: Priority Health SBD |
$51.52
|
| Rate for Payer: UMR Bronson Commercial |
$35.98
|
| Rate for Payer: Van Buren County Sheriff Dept. Commercial |
$61.34
|
|
